Adenosquamous carcinoma of the lung: surgical results as compared with squamous cell and adenocarcinoma cases.

Eur J Cardiothorac Surg. 2011 Jul 5;

Authors: Maeda H, Matsumura A, Kawabata T, Suito T, Kawashima O, Watanabe T, Okabayashi K, Kubota I,

Objectives: An adenosquamous carcinoma (ASC) of the lung is a relatively rare tumor. In this multi-institutional cohort study, we tested the hypothesis that an ASC exhibits more aggressive clinical behavior as compared to adenocarcinoma (AC) and squamous cell carcinoma (SC). Methods: This retrospective cohort study used a prospective database produced by the Japan National Hospital Organization Study Group for Lung Cancer over a 7-year period (operations from 1997 to 2003, follow-up data until March 2010). During that period, 4668 cases underwent an operation for various types of primary malignant lung tumors. When a sample from a tumor comprised at least 20% each of SC and AC, the case was classified as ASC. Pathologic staging was done according to the seventh edition of the International Union against Cancer (UICC) Tumor Node Matastasis (TNM) classification of malignant tumors. Results: We identified 114 patients with ASC (2.4%), 2993 with AC (64.2%), and 1369 with SC (29.3%). Kaplan-Meier survival curves for all stage cases, p-stage IA, IB, and IIIA tumors indicated that ASC cases had the least favorable survival. The 5-year survival rates for all stage cases were 23.3% for ASC, 58.0% for AC (p<0.0001), and 40.8% for SC (p<0.0001). The 5-year survival rates for p-stage IA were 42.0% for ASC, 81.8% for AC (p=0.0005), and 63.4% for SC not significant (NS), while those for p-stage IB were 19.3%, 65.3% (p=0.0024), and 46.8% (NS), respectively, and those for p-stage IIIA were 17.8%, 24.8% (p=0.0154), and 18.8% (NS), respectively. There was a tendency for greater survival differences between ASC and AC in earlier tumor stages. A step-wise multivariable model demonstrated that sex, age, performance status, histology, tumor size, p-stage, operative method, and neoadjuvant/adjuvant therapy were independent prognostic factors. Conclusion: ASC of the lung is more aggressive than AC and SC. The decreased survival of patients with ASC as compared with either of those single histology tumors suggests the need for a clinical trial of adjuvant chemotherapy that includes early-stage patients.

PMID: 21737295 [PubMed - as supplied by publisher]

Pulmonary fibrosis is associated with an elevated risk of thromboembolic disease.

Eur Respir J. 2011 Jul 7;

Authors: Sprunger DB, Olson AL, Huie TJ, Fernandez-Perez ER, Fischer A, Solomon JJ, Brown KK, Swigris JJ

Recent epidemiologic studies have suggested an increased risk of venous thromboembolic disease (VTE) in lung fibrosis. Large-scale epidemiologic data regarding the risk of VTE in pulmonary fibrosis-associated mortality have not been published. Using data from the National Center for Health Statistics from 1988-2007, we determined the risk of VTE in decedents with pulmonary fibrosis in the United States. We analysed 46,450,489 records, of which 218,991 met our criteria for "Idiopathic Pulmonary Fibrosis." Among these, 3,815 records also contained a diagnostic code for VTE (1.74%). The risk of VTE in pulmonary fibrosis decedents was 34% higher than in the background population, and 44% and 54% greater than among decedents with COPD and lung cancer, respectively. Those with VTE and pulmonary fibrosis died at a younger age than those with pulmonary fibrosis alone (for females: 74.3 years vs. 77.4 years, p<0.0001; for men: 72 years vs. 74.4 years, p<0.0001). Decedents with pulmonary fibrosis have a significantly greater risk of VTE. Those with VTE and pulmonary fibrosis die at a younger age than those with pulmonary fibrosis alone. These data suggest a link between a pro-fibrotic and a pro-coagulant state.

PMID: 21737559 [PubMed - as supplied by publisher]

Impact of cigarette smoke exposure on host-bacterial pathogen interactions.

Eur Respir J. 2011 Jul 7;

Authors: Garmendia J, Morey P, Bengoechea JA

The human respiratory tract from individuals with a normal lung function maintains a fine-tuned balance, asymptomatically colonized by the normal microbiota in the upper airways and sterile in the lower tract. This equilibrium may be disrupted by the exposure to insults such as cigarette smoke. In the respiratory tract, the complex and noxious nature of inhaled cigarette smoke alters host-microorganism interaction dynamics at all anatomical levels, causing infections in many cases. Moreover, continuous exposure to cigarette smoke itself causes deleterious effects on the host which can trigger the development of chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and lung cancer. COPD is an irreversible airflow obstruction associated to emphysema, fibrosis, mucus hypersecretion and persistent colonization of the lower airways by opportunistic pathogens. COPD patients keep a stable but progressively worsening condition, and suffer periodic exacerbations caused, in most cases, by infections. Although smoking and smoking associated diseases are associated to high risk of infections, most therapies aim to reduce inflammatory parameters, but not necessarily take into account the presence of persistent colonizers. The effect of cigarette smoke on host-pathogen interaction dynamics in the respiratory tract, together with current and novel therapies is discussed.

PMID: 21737564 [PubMed - as supplied by publisher]

Vitamin a and retinoid derivatives for lung cancer: a systematic review and meta analysis.

PLoS One. 2011;6(6):e21107

Authors: Fritz H, Kennedy D, Fergusson D, Fernandes R, Doucette S, Cooley K, Seely A, Sagar S, Wong R, Seely D

Despite reported antiproliferative activity of vitamin A and its common use for cancer, there is no comprehensive synthesis of its safety and efficacy in lung cancers. To address this issue we conducted a systematic review of the safety and efficacy of vitamin A for the treatment and prevention of lung cancers.

PMID: 21738614 [PubMed - in process]